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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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Home care nursing (HCN)

Page posted: 10/01/03

Page reviewed: 6/1/15

Page updated: 6/1/15

Legal Authority

42 C.F.R. 440.80, Minn. Stat. §256B.0625, Minn. Stat. §256B.0651 and Minn. Stat. §256B.0654

Definition

Home care nursing: Provision of professional nursing services to a person in or outside their home when normal life activities take the person outside the home, including school, with such services based on an assessment of the medical/health care needs of the person.

Covered services

Regular

  • • Assessments and interventions needed by a person who is considered stable but has episodes of instability that are not immediately life threatening
  • • Nursing observation, monitoring, assessment and evaluation to determine appropriate interventions that will maintain or improve the health status of the person
  • Complex

    Nursing provided to a person who is ventilator dependent and/or who requires an intensive level of care as stated in an order of the physician.

    Ventilator dependent consumer

    Nursing for a person dependent on mechanical ventilation for life support for at least six hours a day and who is expected to be or has been dependent for at least 30 consecutive days.

    Consumer in need of an intensive level of care

    People whose medical needs require complex nursing assessments and interventions in response to life-threatening episodes of instability. The interventions are:

  • • Needed immediately based on anticipated or unanticipated changes in the health status of the person.
  • • Ordered by a physician.
  • Non-covered services

  • • Home care nursing services if the nurse is the foster care provider of a person under age 18
  • • Regular home care nursing services to a person who is ventilator dependent or requires an intensive level of care.
  • Provider Standards and Qualifications

    The following Minnesota health care program-enrolled providers may provide home care nursing:

    1. Registered nurse (RN) or licensed practical nurse (LPN) employed by a Medicare-certified agency and/or home care nursing class A licensed agency.
    2. Parent of a minor child, spouse or non-corporate legal guardian who is a RN or LPN employed by an agency and meets criteria to receive a Home Care Nursing Hardship Waiver.
    3. Independent RN.
    4. Independent LPN with a class A license.

    Required documentation

    Submit the following information to DHS:

  • MA Home Care Nursing Assessment (DHS-4071A)
  • • Physician orders
  • • Plan of care
  • Service Agreement (DHS-3070) - submit via ITS software or mail paper form and include the procedure code(s) for the service and start date.
  • Process and Procedures

    MA State Plan Services
    CAC, CADI, BI Waivers

    DD Waiver

    Home Care Nursing Hardship Waiver

    Shared Service Option for home care nursing

    Rates - See Continuing Care and other provider rate changes page

    Process/Procedures: MA State Plan Service

    Effective Date: 10/01/03

    Review Date: 10/01/03

    Access

    To initiate service, anyone may make a referral directly to an approved home care nursing provider.

    Assessment

    Registered nurse, either independent or from an approved home care nursing provider, completes an assessment to determine need, using the MA Home Care Nursing Assessment DHS-4071A (PDF).

    Independent licensed practical nurses (LPN’s) must arrange for the assessment to be completed by a RN (either independent or from an approved provider).

    Assessments identify needs of the person, determine whether regular or complex home care nursing is required to meet those needs and recommend amounts of activities.

    Authorization

    DHS

    1. Reviews assessment information (Need for service, number of units and type of nursing)
    2. Provides authorization (temporary or long-term authorization)
    3. Enters home care rating MMIS (Home Care Nursing Decision Tree DHS-4071-C (PDF)).

    Temporary authorization up to 45 days

    Fax MA Home Care Technical Change Request DHS-4074 (PDF) to DHS.

    Long-term authorization

    Submit the required documentation.

    Extended services

    Not available in the MA State Plan.

    Process/Procedure: BI, CAC, CADI Waivers

    Effective Date: 10/01/03

    Review Date: 6/1/15

    Access

    To initiate services, waiver case managers/service coordinators make referrals to an approved provider.

    Use the long-term care consultation (LTCC) process to assess for determination of need.

    Assessment

    Assessments identify needs, determine whether regular or complex home care nursing is required to meet those needs and recommend amounts of activity.

    Independent licensed practical nurses (LPN’s) must arrange for a RN, either independent or from an approved provider, to complete assessments.

    Registered nurses, either independent or from an approved provider agency, complete assessments to determine needed using the:

    Send a copy of the assessment to the waiver case manager.

    Authorization

    Waiver case managers/service coordinators complete authorization for units after review of the assessment information, need for service, type of nursing, number of units and length of service.

    Extended services

    Waiver case managers/service coordinators:

    1. Authorize extended services based on the number of units the person needs over and above the number of units assessed with the home care nursing assessment form.
    2. Use extended HCPC codes in the MMIS service agreement. Home Care Nursing Decision Tree DHS-4071-C (PDF).

    Process/Procedure: DD Waiver

    Effective Date: 10/01/03

    Review Date: 6/1/15

    Access

    To initiate services, a waiver case manager/service coordinator makes a referral to an approved provider.

    Assessment

    Assessments identify needs, determine whether regular or complex home care nursing is required to meet those needs, and recommend amounts of activities.

    Independent licensed practical nurses (LPN’s) must arrange for a RN, either independent or from an approved provider agency, to complete the assessment.

    Registered nurses, either independent or from an approved provider agency use the:

    Send a copy of the assessment to the waiver case manager.

    Authorization

    Waiver case managers/service coordinators complete authorizations for units after review of:

  • • Assessment information
  • • Length of service
  • • Need for service
  • • Number of units
  • • Type of nursing.
  • Extended services

    Not available in the DD Waiver.

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